Mir Tanveer, Uddin Mohammed, Qureshi Waqas T, Regmi Neelambuj, Tleyjeh Imad M, Saydain Ghulam
Internal Medicine, Detroit Medical Center Wayne State University, 4201, St Antoine St., Detroit, MI, 48201, USA.
Internal Medicine, Baptist Health System, 300 Taylor Road,, Montgomery, AL, 36117, USA.
Infect Dis Ther. 2022 Feb;11(1):305-321. doi: 10.1007/s40121-021-00563-y. Epub 2021 Nov 24.
Literature regarding outcomes and predictors of complications secondary to infective endocarditis (IE) is limited. We aimed to study the outcomes and predictors of complications of IE.
Data from a national emergency department sample, which constitutes 20% sample of hospital-owned emergency departments in the USA, were analyzed for hospital visits for IE. Complications of endocarditis were obtained by using ICD codes. Multivariable generalized linear method was used to evaluate predictors of in-hospital mortality and complications.
Out of 255,838 adult IE patients (mean age 60.3 ± 20.1 years, 48.5% females), 97,803 (38.2%) patients developed one or more major complications. The major complications were cardiovascular system complications [57,900 (22.6%)], neurologic [42,851 (16.7%)] complications, and renal [16,236 (6.4%)] complications. These included cardiogenic shock [3873 (1.5%)], septic shock [25,798 (10.1%)], acute heart failure [35,602 (14%)], systemic thromboembolism (STE) [21,390 (8.36%)], heart block [11,430 (4.47%)], in-hospital dialysis [2880 (1.1%)], and disseminated intravascular coagulation (DIC) [2704 (1.1%)]. Patients with complicated IE had risk of mortality (adjusted RR 1.12, 95% CI 1.11-1.13, p < 0.001). The complications strongly associated with mortality were septic shock (RR 1.29, 95% CI 1.27-1.30, p < 0.001), cardiogenic shock (RR 1.24, 95% CI 1.20-1.29, p < 0.001), DIC (RR 1.4, 95% CI 1.35-1.46, p < 0.001), and STE (RR 1.07, 95% CI 1.05-1.08, p < 0.001). Staphylococci were the predominant causative organisms (30.8%) among the complicated IE subgroups with higher associated mortality (42.8%). The main predictors of complications from IE were congenital heart disease, history of congestive heart failure, high Elixhauser comorbidity profile, staphylococcal infection, and fungal infections. The prevalence of cardiogenic shock increased over the study years from 1.13 to 1.98% (p-trend 0.04).
Complicated IE is not uncommon and is associated with significant mortality. Staphylococcal infections were associated with high mortality rates. There has been an increasing trend of cardiogenic shock among IE patients across the US. Further research is needed to improve the outcomes of complicated endocarditis.
关于感染性心内膜炎（IE）继发并发症的预后及预测因素的文献有限。我们旨在研究IE并发症的预后及预测因素。
对来自美国全国急诊科样本的数据进行分析，该样本占美国医院所属急诊科样本的20%，分析因IE而住院就诊的情况。通过国际疾病分类（ICD）编码获取心内膜炎的并发症。采用多变量广义线性方法评估院内死亡率及并发症的预测因素。
在255,838例成年IE患者（平均年龄60.3±20.1岁，48.5%为女性）中，97,803例（38.2%）患者出现一种或多种主要并发症。主要并发症包括心血管系统并发症[57,900例（22.6%）]、神经系统并发症[42,851例（16.7%）]和肾脏并发症[16,236例（6.4%）]。这些并发症包括心源性休克[3873例（1.5%）]、感染性休克[25,798例（10.1%）]、急性心力衰竭[35,602例（14%）]、系统性血栓栓塞（STE）[21,390例（8.36%）]、心脏传导阻滞[11,430例（4.47%）]、院内透析[2880例（1.1%）]和弥散性血管内凝血（DIC）[2704例（1.1%）]。并发IE的患者有死亡风险（调整后相对危险度1.12，95%置信区间1.11 - 1.13，p < 0.001）。与死亡率密切相关的并发症为感染性休克（相对危险度1.29，95%置信区间1.27 - 1.30，p < 0.001）、心源性休克（相对危险度1.24，95%置信区间1.20 - 1.29，p < 0.001）、DIC（相对危险度1.4，95%置信区间1.35 - 1.46，p < 0.001）和STE（相对危险度1.07，95%置信区间1.05 - 1.08，p < 0.001）。葡萄球菌是并发IE亚组中主要的致病微生物（30.8%），其相关死亡率较高（42.8%）。IE并发症的主要预测因素为先天性心脏病、充血性心力衰竭病史、高埃利克斯豪斯合并症评分、葡萄球菌感染和真菌感染。在研究期间，心源性休克的患病率从1.13%增至1.98%（p趋势=0.04）。
并发IE并不罕见，且与显著的死亡率相关。葡萄球菌感染与高死亡率相关。在美国，IE患者中心源性休克呈上升趋势。需要进一步研究以改善并发心内膜炎的预后。
